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The Perfect Storm: Fat Embolism Syndrome Following Liposuction, Helium Radiofrequency and Targeted Cellulite Subcision
Sarah Mess, MD, Brandon Carr, MD
Plastic Surgery Center of Columbia, Columbia, MD
This is a case report of fat embolism syndrome (FES) immediately following the combination of liposuction, helium radiofrequency (HRF), and targeted cellulite subcision (TCS) of the thighs in a 51 year-old-woman. Fat embolism syndrome is recognized as a triad of pulmonary dysfunction, altered mental status, and petechial rash. Only 23 cases of liposuction related FES have been reported and presentation is acute. In FES, fatty micro-fragments lodge into pulmonary capillaries damaging alveoli and creating a diffuse ground glass appearance on computed tomography (CT). It is theoretically possible that the retractable blade for cellulite subcision inadvertently opened superficial veins, power-assisted-liposuction micronized the fat, and helium gas increased interstitial pressure pushing microscopic fat into circulation. Animal studies have demonstrated 100% occurrence of pulmonary fat embolism with liposuction and human occurrence is thought to be vastly underestimated. In this case, the patient became hypoxic and tachycardic within 45 minutes of LMA removal and return of appropriate speech and awareness. Laboratory values showed severe lactic acidosis, leukocytosis, decreased hemoglobin and precipitous drop in platelets as seen in FES. Additionally, CT of the chest revealed bilateral pulmonary consolidation with ground glass opacity and reticulation in the upper and lower lobes(Figure). The patient recovered with supportive care. We share potential safety considerations when using these multiple modalities. Avéli and Renuvion are effective and generally safe devices, but caution is advised with combining TCS, liposuction, and HRF subsequent to this case of fat embolism syndrome.
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